Why can't COPD pts be on a non rebreather mask?

Chewy20

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I literally forget how that works out.

Who told you they can't be? If someone has low o2 sats you give them oxygen. It may or may not help, if it doesn't then throw them on CPAP with the PEEP set at 5, or 10 if they have fluid in their lungs.

You are not going to shut someone's respiratory drive down by putting on an NRB.
 

COmedic17

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That idea stems from oxygen toxicity. If a pt receives too much oxygen (ex- NRB) theres a risk that you might knock out the patients respiratory drive ( remember people with COPD run off of hypoxic drive as opposed to high co2 levels) , and there's risks of vasoconstriction.

But if a pt needs oxygen-give them oxygen. The goal is an spo2 reading between 94-99% (According to the books)..

However, the studies show with COPD exacterbation you should titrate oxygen since it reduces the likelihood of hypercapnia and respiratory acidosis as opposed to starting right off the bat with high flow O2. Since NRBs have a oxygen resovior bag, they are harder to titrate then say a Venturi mask or nasal cannula or bipap/Cpap.


That's the theory behind it. But I have never had a pt on a NRB exhibit any negative side effects.
 

medicaltransient

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They can. Your thinking of obsorbative atalectasis, it's when you wash out all the nitrogen and they stop making surfactant. Nitrogen is what triggers surfactant to be made. Something like that, look it up on google scholar.
 

Burritomedic1127

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They can. Your thinking of obsorbative atalectasis, it's when you wash out all the nitrogen and they stop making surfactant. Nitrogen is what triggers surfactant to be made. Something like that, look it up on google scholar.
Surfactant is produced in the Type II alveolar cells, most of it is continuously recycled
 

NomadicMedic

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You're actually thinking of the old EMS instructor adage, "if you put oxygen on a COPD patient, it'll kill them because they rely on hypoxic drive."

Untrue. EMS instructors also like to tell tales such as, "if you don't put everyone in a motor vehicle accident on a backboard with a c-collar, they could turn their neck and die."

Or this gem, "if they have a radial pulse, they have a blood pressure of at least 90"

If an EMS instructor ever presents something that results in devastating consequences as an absolute, it's usually BS. Look it up and do some research.
 

DesertMedic66

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You're actually thinking of the old EMS instructor adage, "if you put oxygen on a COPD patient, it'll kill them because they rely on hypoxic drive."

Untrue. EMS instructors also like to tell tales such as, "if you don't put everyone in a motor vehicle accident on a backboard with a c-collar, they could turn their neck and die."

Or this gem, "if they have a radial pulse, they have a blood pressure of at least 90"

If an EMS instructor ever presents something that results in devastating consequences as an absolute, it's usually BS. Look it up and do some research.

The one that I made bold I hear all the time from nurses, medics, and EMTs. I hate when providers say it. I'm surprised with how many medics actually use that as a scale to give meds "they have a radial pulse so we can give nitro"
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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That idea stems from oxygen toxicity. If a pt receives too much oxygen (ex- NRB) theres a risk that you might knock out the patients respiratory drive ( remember people with COPD run off of hypoxic drive as opposed to high co2 levels) , and there's risks of vasoconstriction.

But if a pt needs oxygen-give them oxygen. The goal is an spo2 reading between 94-99% (According to the books)..

However, the studies show with COPD exacterbation you should titrate oxygen since it reduces the likelihood of hypercapnia and respiratory acidosis as opposed to starting right off the bat with high flow O2. Since NRBs have a oxygen resovior bag, they are harder to titrate then say a Venturi mask or nasal cannula or bipap/Cpap.


That's the theory behind it. But I have never had a pt on a NRB exhibit any negative side effects.
Great point about hypoxic drive. Many forget that.
 

captaindepth

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That idea stems from oxygen toxicity. If a pt receives too much oxygen (ex- NRB) theres a risk that you might knock out the patients respiratory drive ( remember people with COPD run off of hypoxic drive as opposed to high co2 levels) , and there's risks of vasoconstriction.

But if a pt needs oxygen-give them oxygen. The goal is an spo2 reading between 94-99% (According to the books)..

However, the studies show with COPD exacterbation you should titrate oxygen since it reduces the likelihood of hypercapnia and respiratory acidosis as opposed to starting right off the bat with high flow O2. Since NRBs have a oxygen resovior bag, they are harder to titrate then say a Venturi mask or nasal cannula or bipap/Cpap.


That's the theory behind it. But I have never had a pt on a NRB exhibit any negative side effects.

I don't believe oxygen toxicity is involved in COPD pts and their dependance on a hypoxic drive. Oxygen toxicity occurs at high partial pressures and can lead to seizures as well as other complications. This is usually experienced in hyperbaric chambers when breathing oxygen enriched air or regular air at deep depths.

Pts with COPD become desensitized high CO2 levels in their blood and there for they may not rely on increased CO2 levels to stimulate increased respirations. They begin to rely on their hypoxic drive to stimulate increased respirations, but I would never with hold O2 from a pt who needs it with the worry that they would all of a sudden stop breathing.
 

COmedic17

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Pts with COPD become desensitized high CO2 levels in their blood and there for they may not rely on increased CO2 levels to stimulate increased respirations. They begin to rely on their hypoxic drive to stimulate increased respirations, but I would never with hold O2 from a pt who needs it with the worry that they would all of a sudden stop breathing.


You do realize you said exactly what I said, right?
 

RedAirplane

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The one that I made bold I hear all the time from nurses, medics, and EMTs. I hate when providers say it. I'm surprised with how many medics actually use that as a scale to give meds "they have a radial pulse so we can give nitro"

It is true that the carotid pulse will be the last to vanish with decreasing blood pressure, right? So, even if not 90mmHg, wouldn't a radial pulse mean that the blood pressure is above some threshold?
 

Akulahawk

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It is true that the carotid pulse will be the last to vanish with decreasing blood pressure, right? So, even if not 90mmHg, wouldn't a radial pulse mean that the blood pressure is above some threshold?
Having a radial pulse means that you have a radial pulse. That's all it really means. It doesn't mean that someone has an SBP over some specific number. Yesterday I (while doing an EMS ride along) had a patient that had a BP of 82/58. I'd call his radial pulse a 2+ in terms of quality... because it was. He probably could have gone as low as having an SBP of 70 or so before losing the radial pulse. Everyone is different so while the SBP may be low, if there's a radial pulse, chances are the patient is still perfusing most organs.
 

jrm818

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Having a radial pulse means that you have a radial pulse. That's all it really means. It doesn't mean that someone has an SBP over some specific number. Yesterday I (while doing an EMS ride along) had a patient that had a BP of 82/58. I'd call his radial pulse a 2+ in terms of quality... because it was. He probably could have gone as low as having an SBP of 70 or so before losing the radial pulse. Everyone is different so while the SBP may be low, if there's a radial pulse, chances are the patient is still perfusing most organs.

And really, the most important organ (or at least the most intolerant of ischemia, even for very short periods) is the one inside your skull. If they're awake, they're definitely perfusing their brain.
 

Brandon O

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It is true that the carotid pulse will be the last to vanish with decreasing blood pressure, right? So, even if not 90mmHg, wouldn't a radial pulse mean that the blood pressure is above some threshold?

Yes. It has some use as a qualitative measure. The military (last I heard anyway) uses it as a marker for fluid resuscitation, along with mental status. Just don't try to put a number on it.
 

Carlos Danger

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Hypoxic drive inhibition and oxygen toxicity are completely separate concepts.

Also, absorption atelectasis has nothing to do with surfactant production.
 

hogwiley

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The reasons people used to say not to put a NRB on someone with COPD is a different issue from oxygen toxicity. Oxygen toxicity is why you should generally use o2 sparingly in any situation unless its to reverse suspected hypoxia, and not just throw people on o2 for the hell of it. I dont know the exact pathophysiology of it but if I remember it has to do with oxygen free radicals causing cellular damage along with other unwanted effects. With COPD the issue is relatively high blood oxygen saturation levels wiping out a COPD patient's hypoxic drive, which is driven by low o2 levels rather than co2 levels.

As most people have said the whole hypoxic drive thing is no longer considered a reason to withhold o2 if a patient is truly hypoxic, but my understanding is that hypoxic drive is still real, its not some urban legend. It just is not something your likely to wipe out giving high flow o2 for a short time, and if by some chance they did stop breathing you can still bag them and if needed go with an advanced airway.
 
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